Specialised Commissioning Sarah Watson, Programme Director Highly Specialised Services – Internal Medicine Yorkshire Thoracic Society 21st March 2014

Introduction Specialised services account for approximately 10% of the total NHS budget, spending circa £12.2 billion per annum The commissioning of specialised services is a prescribed direct commissioning responsibility of NHS England Specialised services are those provided in relatively few hospitals, accessed by comparatively small numbers of patients but with catchment populations of usually more than one million

The 4 Factors Four factors determine whether NHS England commissions a service as a prescribed specialised service. These are: The number of individuals who require the service; The cost of providing the service or facility; The number of people able to provide the service or facility and The financial implications for Clinical Commissioning Groups (CCGs) if they were required to arrange for provision of the service or facility themselves

The Ambition The ambition of NHS England is to bring equity and excellence to the provision of specialised care and treatment. This is achieved through a commissioning process which: is patient-centred and outcome based. The patient must be placed at the centre of planning and delivery. Commissioners, working with providers, must deliver improved outcomes for them across each of the five domains of the 2013/14 NHS Outcomes Framework; is fair, consistent throughout the country, ensuring that patients have equal access to services regardless of their location, and; Improves productivity and efficiency.

Who commissions? NHS England delivers its specialised commissioning responsibilities through its central support team; four regional offices and through 10 of its 27 area teams. The area teams with responsibility for specialised commissioning are: Cumbria, Northumberland, Tyne and Wear South Yorkshire and Bassetlaw Cheshire, Warrington and Wirral East Anglia Leicestershire and Lincolnshire Birmingham and the Black Country Wessex Bristol, North Somerset and South Gloucestershire Surrey and Sussex London

Specialised Commissioning in the North of England Cheshire Warrington and Wirral Cumbria, Northumberland, Tyne and Wear, South Yorkshire and Bassetlaw area teams are responsible for specialised commissioning

The North of England

National Programmes of Care Internal Medicine - digestion, renal, hepatobiliary and circulatory system Cancer and Blood - infection, cancer, immunity and haematology Mental Health Trauma - traumatic injury, orthopaedics, head and neck and rehabilitation Women and Children - women and children, congenital and inherited diseases

Clinical Reference Groups in Internal Medicine PoC A01. Cystic Fibrosis A02. Hepatobiliary and Pancreas A03. Specialised Endocrinology A04. Vascular Disease A05. Severe and Complex Obesity A06. Renal Dialysis A07. Renal Transplant A08. Specialised Colorectal Services A09. Complex Invasive Cardiology A10. Cardiac Surgery A11. Pulmonary Hypertension A12. Specialised Dermatology A13. Specialised Rheumatology A14. Specialised Respiratory A15. Interventional Radiology A16. Specialised Imaging A17. Specialised Diabetes A18. Heart & Lung Transplantation

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Specialised Respiratory CRG The services encompassed by this Clinical Reference Group (CRG) include: the management of patients with complex respiratory disease who need assisted ventilation at home; services for people with severe and difficult to control asthma; services for people with interstitial lung disease.

Specifications: Ataxia telangiectasia service (Adult) Respiratory Complex Home Ventilation (Adult) Respiratory Severe Asthma (Adult) Respiratory Interstitial Lung Disease(Adult) Chronic Pulmonary Aspergillosis Service (Adults)

Compliance Exercise Nearly 200 specifications for specialised services Whilst these specifications were used to inform the 2013/14 contracting round, they only became a requirement of providers as of 1 October 2013 NHS England established a process in order to assess levels of provider compliance against key requirements set out in the service specifications The compliance exercise forms part of an iterative process of improvement

Specialised Respiratory Specifications Paused for 13/14 Difficulties with capturing activity In contract by April 2014 Delayed start with Provider/ AT discussions Parts of the country have made more progress than others agreeing contracts (no different from some of the other specialities)

Key Requirements A14/S/a Respiratory: Complex Home Ventilation (Adult) In patient weaning beds and on site ITU At least two consultants with expertise in respiratory physiology, weaning and complex ventilation 24/7 specialist consultant on call cover and resident specialist respiratory or critical care registrar with direct responsibility for the Unit Specialist respiratory and rehabilitation physiotherapist

Progress Specialised Commissioners working with trusts that indicated compliance with the service specification and seeking assurance of their full compliance with all elements of the national service specification

Policies being drafted Bronchial thermoplasty for chronic asthma Inflixumab for refractory sarcoidosis Rituxumab for CTD-ILD Chronic pulmonary aspergillosis (Adult) Others?

Website http://www.england.nhs.uk/ourwork/commissioning/spec-services/